TY - JOUR
T1 - A metaanalysis of predischarge risk stratification after acute myocardial infarction with stress electrocardiographic, myocardial perfusion, and ventricular function imaging
AU - Shaw, Leslee J.
AU - Peterson, Eric D.
AU - Kesler, Karen
AU - Hasselblad, Vic
AU - Califf, Robert M.
PY - 1996
Y1 - 1996
N2 - We assessed the relation of abnormal predischarge noninvasive lest results to outcomes in postmyocardial infarction patients. We included series published from 1980 to 1995 containing only myocardial infarction patients, enrolling most patients after 1980, testing within 6 weeks of infarction, having follow-up rates >80%, and having 2 × 2 frequency outcome rates for test results, that were the latest of multiple reports. Sensitivity, specificity, and predictive values were calculated for test results for 1-year outcomes (cardiac death, cardiac death or reinfarction). Univariable and summary odds were calculated for test results. Reports (n = 54) included a total of 19,874 patients and were primarily retrospective (76%) and small series (35% of reports included <5 deaths). One-year mortality ranged from 2.5% for pharmacologic stress echocardiography to 9.3% for exercise radionuclide angiography. Positive predictive values for most noninvasive risk markers were <0.10 for cardiac death and <0.20 for death or reinfarction. Electrocardiographic, symptomatic, and scintigraphic risk markers of ischemia (ST-segment depression, angina, a reversible defect) were less sensitive (≤44%) for identifying morbid and fatal outcomes than markers of left ventricular dysfunction or heart failure (exercise duration, impaired systolic blood pressure response, and peak left ventricular ejection fraction). The positive predictive value of predischarge noninvasive testing is low. Markers of left ventricular dysfunction appear to be better predictors than markers of ischemia. Limitations of the literature - small samples and widely varying event rates - impede our ability to discern the accuracy of predischarge noninvasive testing. More rigorous, controlled trials are required to elucidate the relative value of these tests for risk stratification.
AB - We assessed the relation of abnormal predischarge noninvasive lest results to outcomes in postmyocardial infarction patients. We included series published from 1980 to 1995 containing only myocardial infarction patients, enrolling most patients after 1980, testing within 6 weeks of infarction, having follow-up rates >80%, and having 2 × 2 frequency outcome rates for test results, that were the latest of multiple reports. Sensitivity, specificity, and predictive values were calculated for test results for 1-year outcomes (cardiac death, cardiac death or reinfarction). Univariable and summary odds were calculated for test results. Reports (n = 54) included a total of 19,874 patients and were primarily retrospective (76%) and small series (35% of reports included <5 deaths). One-year mortality ranged from 2.5% for pharmacologic stress echocardiography to 9.3% for exercise radionuclide angiography. Positive predictive values for most noninvasive risk markers were <0.10 for cardiac death and <0.20 for death or reinfarction. Electrocardiographic, symptomatic, and scintigraphic risk markers of ischemia (ST-segment depression, angina, a reversible defect) were less sensitive (≤44%) for identifying morbid and fatal outcomes than markers of left ventricular dysfunction or heart failure (exercise duration, impaired systolic blood pressure response, and peak left ventricular ejection fraction). The positive predictive value of predischarge noninvasive testing is low. Markers of left ventricular dysfunction appear to be better predictors than markers of ischemia. Limitations of the literature - small samples and widely varying event rates - impede our ability to discern the accuracy of predischarge noninvasive testing. More rigorous, controlled trials are required to elucidate the relative value of these tests for risk stratification.
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U2 - 10.1016/S0002-9149(96)00653-4
DO - 10.1016/S0002-9149(96)00653-4
M3 - Article
C2 - 8970402
AN - SCOPUS:0030589273
SN - 0002-9149
VL - 78
SP - 1327
EP - 1337
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 12
ER -